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Journal of Thoracic Oncology : Official... Sep 2014Anterior mediastinal masses are relatively uncommon, include a wide variety of entities, and often pose a diagnostic challenge for clinicians. In this article, available... (Review)
Review
Anterior mediastinal masses are relatively uncommon, include a wide variety of entities, and often pose a diagnostic challenge for clinicians. In this article, available data is assembled in a clinically oriented manner to develop a structured approach to evaluation of these patients. Attention to age and gender, combined with identification of certain radiographic and clinical characteristics, allows a presumptive diagnosis to be established in most patients. This structure efficiently guides what additional workup is needed.
Topics: Humans; Magnetic Resonance Imaging; Mediastinal Neoplasms; Mediastinum; Radiography
PubMed: 25396306
DOI: 10.1097/JTO.0000000000000294 -
Mediastinum (Hong Kong, China) 2020The mediastinum is the visceral compartment of thoracic cavity divided into the superior and inferior mediastinum, further inferior compartmentalize into anterior,... (Review)
Review
The mediastinum is the visceral compartment of thoracic cavity divided into the superior and inferior mediastinum, further inferior compartmentalize into anterior, middle, and posterior mediastinum. Lymphoma in the mediastinum may be primary or secondary to systemic disease. Lymphoma may arise from lymphoid organs-like thymus, mediastinal lymph nodes or other mediastinal organs like heart, lung, pleura, and pericardium. It comprises about 12% of all the mediastinal tumors in adults however, it constitutes 50% of the pediatric mediastinal mass. Anatomically lymphoma most commonly involves anterior mediastinum. Among the pediatric mediastinal lymphomas, lymphoblastic lymphoma (LBL) predominate followed by Hodgkin lymphoma (HL), primary mediastinal large B cell lymphoma (PMBCL) and very rarely Grey zone lymphoma. Other types of non-HLs (NHLs) are rare among pediatric population. Radiologically and clinically present as an anterior mediastinal mass with symptoms of dyspnea, cough, and superior vena cava syndrome. Also, clinically and radiologically all the pediatric mediastinal mass shares the overlapping features, hence, for treatment and prognostic points of view its essential to differentiate the three entities, i.e., LBL, HL and PMBCL. The pathological diagnosis of pediatric mediastinal lymphomas is quite challenging for general histopathologists. In this review, we describe the pathology, genetics, differential diagnosis, treatment, prognosis, and a simplified histopathological and immunophenotypical approach to differentiate the pediatric mediastinal lymphomas.
PubMed: 35118290
DOI: 10.21037/med-20-37 -
Journal of Cancer Research and... 2021Mediastinal masses span a wide histopathological and radiological spectrum. Apart from primary thymic/thyroid masses and lymphomas, all other mediastinal masses can be... (Review)
Review
Mediastinal masses span a wide histopathological and radiological spectrum. Apart from primary thymic/thyroid masses and lymphomas, all other mediastinal masses can be considered rare tumors. Chest radiography and Computed tomography (CT) are helpful to characterize the mass and can reach a diagnosis or a close differential diagnosis. MRI in special situations can depict the pericardial/vascular invasion better, and diffusion studies can recognize benign from the malignant mass. The imaging details of 15 histopathologically proven cases of rare mediastinal tumors are described. Neuroblastoma (NB) (n = 3) was the most common among the rare masses. Three were sarcomas, one liposarcoma, one synovial sarcoma, one spindle-cell tumor and one Hemangiopericytoma (HPC). Lymphoma presenting as a single mass, neuroendocrine tumor (NET) of the anterior mediastinum, paraganglioma of the posterior mediastinum (one each) were seen.The imaging features of these rare mediastinal masses have to be kept in mind for appropriate diagnosis.
Topics: Humans; Lymphoma; Magnetic Resonance Imaging; Mediastinal Neoplasms; Neuroblastoma; Thymus Neoplasms; Thyroid Neoplasms; Tomography, X-Ray Computed
PubMed: 33723126
DOI: 10.4103/jcrt.JCRT_587_19 -
Mediastinum (Hong Kong, China) 2019A wide variety of lesions can manifest as a localized tumor or mass in the anterior mediastinum. The radiological evaluation of these patients begins with chest... (Review)
Review
A wide variety of lesions can manifest as a localized tumor or mass in the anterior mediastinum. The radiological evaluation of these patients begins with chest radiograph and is followed by CT or MRI. CT and MR imaging allow visualization of the exact location of the lesions. The International Thymic Malignancy Interest Group (ITMIG) has introduced a new definition of mediastinal compartments to be used with cross-sectional imaging and adopted as a new standard. This clinical classification defines a 3-compartment model of prevascular (anterior), a visceral (middle), and a paravertebral (posterior) compartment, with anatomic boundaries defined clearly by computed tomography. The most common masses in the prevascular compartment include thymic abnormalities (cysts, hyperplasia, thymoma, thymic carcinoma, and neuroendocrine tumors), germ cell neoplasms, and lymphoma. Metastatic lymphadenopathy and intrathoracic goiter are sometimes seen.
PubMed: 35118245
DOI: 10.21037/med.2019.04.05 -
Mediastinum (Hong Kong, China) 2023A wide variety of neoplastic and nonneoplastic conditions occur in the mediastinum. Imaging plays a central role in the evaluation of mediastinal pathologies and their... (Review)
Review
A wide variety of neoplastic and nonneoplastic conditions occur in the mediastinum. Imaging plays a central role in the evaluation of mediastinal pathologies and their mimics. Localization of a mediastinal lesion to a compartment and characterization of morphology, density/signal intensity, enhancement, and mass effect on neighboring structures can help narrow the differentials. The International Thymic Malignancy Interest Group (ITMIG) established a cross-sectional imaging-derived and anatomy-based classification system for mediastinal compartments, comprising the prevascular (anterior), visceral (middle), and paravertebral (posterior) compartments. Cross-sectional imaging is integral in the evaluation of mediastinal lesions. Computed tomography (CT) and magnetic resonance imaging (MRI) are useful to characterize mediastinal lesions detected on radiography. Advantages of CT include its widespread availability, fast acquisition time, relatively low cost, and ability to detect calcium. Advantages of MRI include the lack of radiation exposure, superior soft tissue contrast resolution to detect invasion of the mass across tissue planes, including the chest wall and diaphragm, involvement of neurovascular structures, and the potential for dynamic sequences during free-breathing or cinematic cardiac gating to assess motion of the mass relative to adjacent structures. MRI is superior to CT in the differentiation of cystic from solid lesions and in the detection of fat to differentiate thymic hyperplasia from thymic malignancy.
PubMed: 37701642
DOI: 10.21037/med-22-53 -
European Respiratory Review : An... Dec 2021The diagnosis of a mediastinal mass may be challenging for clinicians, since lesions arising within the mediastinum include a variety of disease entities, frequently... (Review)
Review
The diagnosis of a mediastinal mass may be challenging for clinicians, since lesions arising within the mediastinum include a variety of disease entities, frequently requiring a multidisciplinary approach. Age and sex represent important information, which need to be integrated with imaging and laboratory findings. In addition, the location of the mediastinal lesion is fundamental; indeed, we propose to illustrate mediastinal diseases based on the compartment of origin. We consider that this structured approach may serve as hint to the diagnostic modalities and management of mediastinal diseases. In this review, we present primary mediastinal tumours in the evolving context of new diagnostic and therapeutic tools, with recently described entities, based on our own experience with >900 cases encountered in the past 10 years.
Topics: Diagnostic Imaging; Humans; Mediastinal Neoplasms; Mediastinum
PubMed: 34615701
DOI: 10.1183/16000617.0309-2020 -
International Journal of Surgery Case... 2018Mediastinal Ectopic Thyroid Gland is a rare entity, accounting for 1% of all mediastinal tumours. Here, we present a rare case of mediastinal mass that was proved to be...
INTRODUCTION
Mediastinal Ectopic Thyroid Gland is a rare entity, accounting for 1% of all mediastinal tumours. Here, we present a rare case of mediastinal mass that was proved to be an ectopic thyroid with normal thyroid function tests and normal thyroid gland in the cervical location.
CASE PRESENTATION
A 32-year-old lady had a road traffic accident, with the incidental discovery of a mediastinal mass on chest radiography. Thyroid function tests were normal. CT scans of the neck and chest revealed a large mediastinal mass compressing the trachea from the left side and extending to the superior part of the anterior mediastinum with normal thyroid gland in the cervical position. Midline Partial Sternotomy was done with complete surgical excision of the mass. It was well circumscribed, multinodular, had firm inconsistency, and grossly looked like a thyroid tissue. Histopathology revealed ectopic thyroid tissue negative for malignancy. Postoperative thyroid ultrasound showed normal thyroid lobes in the neck.
DISCUSSION
Ectopic thyroid tissue (ETT) occurs due to failure of the thyroid gland to migrate from foramen ceacum to its normal position in the cervical region in front of the trachea. The most common site of ETT is lingual thyroid and accounts for about 90% of all cases reported in the literature. ETT in the mediastinum is very rare, with only a few cases reported in the literature.
CONCLUSION
ETT in the mediastinum is very rare and can be associated with normal thyroid function and normal thyroid anatomical location. It should be differentiated from substernal goiter.
PubMed: 30292094
DOI: 10.1016/j.ijscr.2018.09.033